Trade name: Fevarin
Fluvoxamine: an antidepressant with unexpected aspects
Fluvoxamine is a member of the selective serotonin reuptake inhibitors (SSRIs) group, but it’s hard to call it a “typical” antidepressant. It has characteristics that make it unique. Some patients praise its mild effect, while others complain about its slow onset of action. In any case, it’s important to understand when and how to use it.
Fluvoxamine blocks serotonin reuptake, increasing its concentration in synapses. This is the classic mechanism of SSRIs, but fluvoxamine has additional properties. It inhibits liver enzymes CYP1A2 and CYP2C19, which slows down the breakdown of melatonin and promotes its accumulation. This is why it exhibits mild sedative effects.
Moreover, fluvoxamine practically does not interact with muscarinic, histaminergic, and alpha-adrenergic receptors, reducing the risk of cardiotoxicity and hypotension.
Fluvoxamine is not characterized by rapid action. Physical activity improves first: it becomes easier to get out of bed and perform daily tasks. Then, cognitive functions improve: thoughts become clearer, and sounds and colors more vivid. Emotional improvement comes more slowly, which can cause frustration in patients.
One of the advantages of fluvoxamine is that it less frequently causes emotional apathy compared to other SSRIs. Instead, a slight sense of optimism or even short-term euphoria may appear. Its main achievement is mood stabilization.
A key strength of fluvoxamine is its ability to reduce autonomic symptoms such as excessive sweating, tremors, and rapid heartbeat. This effect is particularly helpful for panic attacks and anxiety disorders.
Fluvoxamine is often prescribed at night due to its sedative effect. However, it doesn’t always help with quick sleep onset but deepens sleep and reduces the frequency of nighttime awakenings. In some cases, it can cause insomnia or daytime drowsiness.
The calming effect of fluvoxamine is more pronounced than its sedative one. It manifests as mild sleepiness, reduced emotional tension, and less desire for social interaction. However, it’s important to remember that calming is not the same as full anxiolytic action, which develops later.
When is fluvoxamine needed?
Fluvoxamine is effective in treating the following conditions:
- Mild to moderate depression, especially somatized and masked.
- Obsessive-compulsive disorder (OCD).
- Social phobia and panic attacks.
Fluvoxamine helps reduce the frequency and severity of panic attacks, though it doesn’t always eliminate them completely. For maximum effect, combining pharmacological treatment with psychotherapy is recommended.
Side effects
Fluvoxamine has side effects common to other SSRIs, such as nausea, vomiting, and diarrhea, due to increased serotonin levels in the intestines. However, it also has some specific risks:
- Hepatotoxicity: Monitoring liver function is recommended, especially at the beginning of treatment.
- Sexual dysfunction: Temporary libido reduction and delayed ejaculation may occur in some patients.
- Increased appetite: Less common and less intense than with paroxetine or tetracyclic antidepressants.
- Dry mucous membranes: Dry eyes can be relieved with artificial tear drops.
- Restless legs syndrome: Usually at high doses (150 mg and more).
- Frequent urination: More common with doses exceeding 200 mg.
Dosage and administration specifics
Treatment starts with 50 mg at night. The therapeutic dose ranges from 100 to 150 mg per day, and in cases of OCD, it can reach 250-300 mg. Due to its long half-life (18-22 hours), the medication is usually taken once a day. At higher doses, administration is divided into 2-3 times per day.
Fluvoxamine acts slowly. The first effects may be noticeable after 1.5-2 months, and in OCD treatment, even later. However, due to its prolonged action, it is particularly effective for chronic disorders.
Fluvoxamine inhibits CYP450 system enzymes, leading to increased concentrations of many medications, including psychotropic drugs. Alcohol consumption is strictly prohibited due to the risk of serious complications.
Fluvoxamine causes a relatively mild withdrawal syndrome. Abrupt discontinuation may lead to dizziness, nausea, headaches, and the characteristic sensation of “electric shocks in the head” (“brain zaps”). To avoid this, the dose should be reduced gradually.
Summary
Fluvoxamine is a drug for those prepared for long-term treatment and who understand that the effects are not immediate. With the right approach and patience, it can become solid support in the fight against depression, anxiety disorders, and obsessive-compulsive conditions.
If you want to discuss appropriate treatment or simply understand your symptoms, book a consultation at the Plexus center, located in Warsaw — we have a psychiatrist who speaks Russian and Polish, who will find a solution tailored to your needs.